Kidney transplants found safe in HIV patients

BOSTON Thu Nov 18, 2010 11:24am EST

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BOSTON (Reuters) - People infected with HIV can safely receive a kidney transplant, researchers reported on Wednesday.

The finding, published in Thursday's New England Journal of Medicine, is good news for people with the virus, who are more prone to kidney disease, in part because of the drugs they must take to stay healthy.

Before drug cocktails turned HIV from a death sentence to a chronic condition, patients were not eligible to receive a kidney.

But now they can. "Patient and graft survival are really pretty good and it approximates the general population," Dr. Peter Stock of the University of California San Francisco, who led the study, said in a telephone interview.

But the news was not uniformly good. Rejection rates were two to three times higher than normal, which surprised Stock.

"It's not that dramatic and we've been able to reverse them," said Stock. "But we know that each rejection episode takes a little bit of life out of a kidney. So instead of lasting 20 years, it might last 15 years. That's why it's very important to figure that out."

His team studied 150 patients treated at 19 U.S. medical centers.

The patients, who were followed for up to three years after their transplants, had a 95 percent survival rate at one year and an 88 percent rate by the three-year mark. Ninety percent of the kidneys were still functioning after one year; 74 percent by the third year.

Those success rates are between what would be expected for all recipients and those age 65 and older.

Eleven of the 150 died. The deaths were caused by heart problems, cancer in the old kidney, bacterial and lung infections.

Stock said there was no evidence that the transplant process caused a resurgence of the HIV, even though the number of protective white blood cells did initially decline.

"HIV simply doesn't progress," said Stock, adding that the same phenomenon has been seen among liver transplant recipients.

In the past, doctors had been concerned that the drugs needed to prevent rejection of the kidney might interfere with the drugs that keep the virus under control.

In a commentary, Dr. Lynda Anne Szczech of Duke University Medical Center in Durham, North Carolina, said the next step is to develop effective treatments for all HIV-related kidney diseases before they progress to near-complete kidney failure.

SOURCE: link.reuters.com/nug26q and link.reuters.com/pug26q New England Journal of Medicine, November 18, 2010.

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